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� <br /> APPLICATION FOR SANITATION PERMIT Permit No ` <br /> � <br /> (Complete in Duplicate)' Dofe Issued - <br /> ' <br /> by m ado to the San Joaquin Local Health Dist rict for a permit to construct and install the work herein described. <br /> / <br /> ..� . .s Made in compliance w4 County Orclin�nce No. 549. <br /> ��wcwA-y 2,6. ) <br /> JO ( <br /> CharacterOwner's Name--� <br /> �9�=7 - --------------------------- <br /> ----------------------------------------------------------- <br /> Installation will serve: Residence ER-'-A-parfment House El Commercial E] Trailer Court F] Motel E] Other C] <br /> Number of living units: Number of bedrooms--3- Number of baths -/--- Lot size <br /> Water Supply: Public system 0--`Communify system El Private E] Depth to Water Table,�ff. <br /> of ___ to _ __r., ,. _ .,,.. ,.,. E] Gravel E] ^a,"' Loam El ~=y `""m [:] Clo Aoo`oe;R Hardpan <br /> -LJ <br /> Previous Application Made: Yes [] No o�- ^me° Construction: Ye` � [] FHA/VA.^ oYNo <br /> ��`~ � <br />-- TYPE OF INSTALLATION AND SPECIFICATIONS: ^�~ <br /> (No septic tank or'cesspool Hf 6available � l <br /> Se t* / x: Distance from neore� won.�*�W[Di +o from foundation Z� i <br /> �9~ Nn. of compu,fmonfo----c9L---- SZ--K-3-1 <br /> DisposalField: D;dance from |F7ZP��/Di�t�nca <br /> . �-- <br /> ' <br /> --- <br /> Number of lines 3 -Length of each || offrench--�"��� v~--------- <br /> [,pn of filter maferiu|.S,/ Depth of filter material - »~---Tv '/ length---. -'' 21-7]P---- <br /> Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance h, no°,e` lot |inc------- <br /> -_- <br /> F-1 Number of pits----------------------Lining material.--�'��'''-S�e: Diameter------------------------ '--�-'-''-''' <br /> � <br /> Cesspool: Distance from nearest waU---_-.-Distance from fqUndafion-------------------Lining material -------.----- <br /> ` [] Size: D7ume+ec-------..----- ------Depth--.-'--/---------------------------------Liquid Capacity----------------------------gal,, <br /> Privy Distance from nearest well -'''-���-�-'''''''--Distance from nearest bu36;ng-------------------------------- -'... <br /> L� Distance to nennux+ lot line`---�------_--.-_--__-_._'-.----_---_----_-------. <br /> ' �Remodeling n ' r napo�r;ng (describe):-. ------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -------------____.__-_-__------__.----_-.__--------_--.__._.__._-_------..__----------.-.. <br /> —'------r-'-'-'--'-----'---'---''----'----'----'-'----'-'---'-----'-''''''-__-'--''---'-�-'- <br /> --'--__'__---_-__..-__.-..__-'_.._-_.'---_'-_---____----__'_-._�--_----.-_-----' <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> �falla S, and rules and regulations of.the -San.,.Joaquin Local Health District. <br /> ��nau�-_,��mm------. '- <br /> By---------------------------------- (Title)--------oi�------------------------------------------ <br /> -q--** - ------------------------ --------------------------------------------------------- <br /> (Plot plan, showing size of lot, location of system * elation to Wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> , --'--_-__---_. . <br /> '-'---'-----7�*~»�—�'��~~-~~�^~�°*^* = '°^'�^^�""�~^�-==~'��^°=�'�-"�=��`^--------'-'' <br /> '--'__-_-''''''-_-'-''-_''-''_'''-''-'-'-''''-''/'�.'�-''''''--.'''-'-'__----------------------------------------------------- <br /> --------------------------------------------------------------------------------------------------------- --------------------------------------------------'' --------------------------------------------------- <br /> FINAL <br /> ''��'-'-'-'-'--' � <br /> ' iv� - <br /> �NAL INSPECTION 8Y�.---------.��/--------. Date-----.-qD|».. Sl--------------.. <br /> ` <br /> SAN JOAQU|N LOCAL HEALTH DISTRICT <br /> /on nv"m Am°ri"o".ytr°of uooWesf.o°kStreet 132 Sycamore St=et ' uw worth 'xr' Street � <br /> Stockton, California Lodi, California w".n+eca, o°Vfomia rmcv California ' <br /> ss--9_2wx°.�s°d 1.57 F-pmu ~ <br /> 0 <br />